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C H U B B® Liability Insurance <br />Endorsement <br />Policy Period <br />Effective Dale <br />Policy Number <br />Insured <br />Name of Company <br />Date Issued <br />This Endorsement applies to the following forms: <br />GENERAL LIABILITY <br />Who Is <br />An Insured <br />Scheduled Person Or <br />Organization <br />August 1, 2021 -August 1, 2022 <br />August 1, 2021 <br />3579-87-11 <br />HOLLAND & KNIGHT <br />GREAT NORTHERN INSURANCE COMPANY <br />Under Who Is An Insured, the following provision is added: <br />Subject to all of the terms and conditions of this insurance, any <br />any person or organization shown in the Schedule, acting pursuant <br />to a written contract or agreement between you and such person or <br />organization, is an insured.; but they are insureds <br />only with respect to liability arising out of your operations, or <br />your premises, if you are obligated, pursuant to such contract <br />or agreement, to provide them with such insurance as is afforded <br />by this policy. <br />However, no such person or organization is an insured <br />with respect to any: <br />assumption of liability by them in a contract or agreement. <br />This limitation does not apply to the liability for damages <br />for injury or damage, to which this insurance applies, that <br />the person or organization would have in the absence of such <br />contract or agreement. <br />• damages arising out of their sole negligence. <br />Schedule <br />Liablllty Insurance ADDL INS - SCHEDULED PERSON OR ORGANIZATION <br />Form 80-02 2373 (Ed. 4-94) Endorsement <br />e , RiskMmWmentDMsian <br />�40 1°x REVIEWED & APPROVED BY: <br />V"° <br />--� Risk janagement Analyst <br />